June 7, 2013

Bio Dirt Commonly Found In Colonoscopy, Endoscopy Equipment

Feeling a little violated by the idea of getting a colonoscopy? Well a new study of several hospitals in the US shows there is a little more to worry about than just that invasion of privacy.

After conducting tests at five hospitals researchers said they determined that three out of 20 flexible gastrointestinal (GI) endoscopes used for screening harbored unacceptable levels of "bio dirt," which is cells and matter from a patient's body. In other words, there is a 15 percent chance of cells and matter from a previous patient violating you along with the endoscope.

"Three out of 20 is an unexpectedly high number of endoscopes failing a cleanliness criterion," said Marco Bommarito, PhD, lead investigator of the study published in American Journal of Infection Control. "Clearly, we'd like no endoscopes to fail a cleanliness rating."

The team analyzed 275 flexible duodenoscopes, gastroscopes, and colonoscopes for the study and found that 30 percent, 24 percent and three percent respectively did not pass a cleanliness rating.

In the last few years there have been reports of improperly cleaned endoscopes at healthcare facilities across the country, including the Veterans Administration where thousands of patients required testing for HIV and hepatitis B and C. The Centers for Disease Control and Prevention (CDC) found that more healthcare-associated outbreaks have been linked to contaminated endoscopes than any other medical device.

There are between 15 and 20 million endoscopy procedures conducted with reusable endoscope devices to screen various components of a patient's GI tract. These devices allow healthcare providers to investigate the surface of this organ and identify issues like polyps or colon cancer. After an endoscope is used by the doctor it is sent for cleaning before being reused with another patient. The cleaning process involves manually cleaning with an enzymatic cleaner and soaking the device in a high-level disinfectant, then a visual inspection to ensure cleanliness.

According to the study, after the manual cleaning step of the decontamination and disinfection process, cleaning technicians at five hospitals across the US were asked to flush the scopes with sterile water, and this sample was analyzed by researchers for a marker of bio contamination known as adenosine triphosphate (ATP). They saw a number of these instruments have higher contamination levels than allowed.

"The cleaning protocols for flexible endoscopes need improvement, such as guidelines tailored to the type of scope or identifying if there is a critical step missing in the manual cleaning process, and documented quality control measures" said Dr. Bommarito. "These types of improvements could have a positive impact on patient safety."